Oropharyngeal and Nasopharyngeal Suctioning of Meconium-Stained Neonates Before Delivery of Their Shoulders: Multicenter, Randomized, Controlled Trial

Abstract

Infants born through meconium-stained amniotic fluid (MSAF) are at risk of meconium aspiration syndrome (MAS), a life-threatening respiratory disorder. Conflicting claims are made about the effectiveness of intrapartum suctioning of MSAF by the oropharyngeal and nasopharyngeal routes. This randomized, controlled trial was conducted at 11 Argentinian centers and 1 in the United States. A total of 2514 patients with MSAF of any consistency, at a gestational age of at least 37 weeks and in cephalic presentation, were randomly assigned to suctioning of the oropharynx and nasopharynx, including the hypopharynx, or to no suctioning. Suctioning was done before the shoulders were delivered. Infants born vaginally or by cesarean section were suctioned, beginning oropharyngeally and followed by bilateral nasopharyngeal suctioning when possible. Pharyngeal suctioning was avoided after delivery unless there was clinically evident airway obstruction. Demographic variables were comparable in the 2 treatment groups, as were the frequency of thick MSAF, the rate of cesarean section, and an abnormal fetal heart rate. MAS was comparably frequent in the 2 groups, as was the need for mechanical ventilation and the number of infants who died. Four infants in the suctioning group and 2 in the no-suction group died of respiratory failure. Mortality in all infants with MAS was 10.1%. The type of management made no appreciable differences in the duration of oxygen treatment, mechanical ventilation, or hospital care. There also were no substantial differences in the frequency of other respiratory disorders, the risk of pneumothorax, 1- or 5-minute Apgar scores, or the need for positive-pressure ventilation in the delivery room. Prenatal suctioning caused no complications. The investigators believe that, in term meconium-stained infants, MAS and its complications are not prevented by routine intrapartum oropharyngeal and nasopharyngeal suctioning.